# COMMONWEALTH MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477500361
- **Authorized official:** MR. JOHN A. MUTSCHELKNAUS (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (414) 777-5100

## Contact information

- **Practice address:** 851 S 70TH ST, SUITE 101, WEST ALLIS, WI 53214-3147
- **Practice address phone:** (414) 777-5100
- **Practice address fax:** (414) 777-5112
- **Mailing address:** 851 S 70TH ST, SUITE 101, WEST ALLIS, WI 53214-3147
- **Mailing address phone:** (414) 777-5100
- **Mailing address fax:** (414) 777-5112

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133V00000X | Registered Dietitian | 1314-029 | WI | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | — |
| 207RP1001X | Pulmonary Disease Physician | — | — | — |
| 207UN0901X | Nuclear Cardiology Physician | — | NULL | — |
| 207UN0901X | Nuclear Cardiology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 2085R0202X | Diagnostic Radiology Physician | — | NULL | — |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |
| 2085U0001X | Diagnostic Ultrasound Physician | — | NULL | — |
| 2085U0001X | Diagnostic Ultrasound Physician | — | — | — |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 2251H1200X | Hand Physical Therapist | — | NULL | — |
| 2251H1200X | Hand Physical Therapist | — | — | — |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 05/27/2006
- **Last updated:** 10/09/2007